One of Gateshead Safeguarding Adults Board's key actions is to develop training for front line practitioners that is guided by learning from reviews and inquiries. This may include bespoke training on particular themes and topics identified during reviews and inquiries, but the board also provides multi-agency interactive workshops which allow practitioners to focus and review the learning from particular cases.
The 2014 Care Act placed a statutory duty for Safeguarding Adults Boards to carry out Safeguarding Adult's Reviews (SARs) in cases where an adult with care and support needs dies or comes to serious harm as a result of abuse or neglect and there is reasonable cause for concern about how the SAB, members of it, or other persons with relevant functions worked together to safeguard the adult.
A SAR must be carried out if:
- There is a reasonable cause for concern about how the SAB, its members or other persons involved worked together to safeguard the adult; and
- The adult has died and it is known or suspected that the death resulted from abuse or neglect; or
- The adult is alive but it is known or suspected that they have experienced serious abuse or neglect.
Overall purpose of a SAR is to promote learning and improve practice, not to re-investigate or to apportion blame. SARs can be useful to:
- Learn from how professionals and their agencies work together
- Evaluate the effectiveness of safeguarding procedures
- Identify learning and good practice issues
- Understand how to improve local inter-agency practice
- Support service improvement or development needs for one or more service or agency.
Some of the cases used in the interactive workshops are not mandatory Safeguarding Adult Reviews (SARs) but are discretionary learning reviews which have been undertaken where the referral did not meet the criteria for a mandatory SAR but there is learning to be taken from the case.
Stephen SAR - Teeswide SAB
The Stephen SAR, which was conducted by the Teeswide SAB, focused on the death of gentleman with a learning disability at the age of 56. Stephen had follicular lymphoma, however he contracted Covid and died of Covid pneumonitis.
The SAR Interactive workshop focused on the working in partnership with families, partnership working between agencies, shielding people with health conditions during Covid, tenancy decisions for people with a learning disability, the availability of specialist services during the pandemic and understanding by practitioners of Lasting Power of Attorney (LPA) and Mental Capacity Act assessments.
Further information on the Stephen SAR can be found on the Teeswide Safeguarding Adults Board website:
Safeguarding Adults Reviews (SARs) Reports | Teeswide Safeguarding Adults Board (tsab.org.uk)
Mrs VC Appreciative Inquiry - Gateshead SAB
The Mrs VC Appreciative Inquiry was undertaken by the Gateshead Safeguarding Adult Review and Complex Case Sub Group. The objectives of the inquiry were to determine good practice and areas for improvement in:
o Communication between partner agencies
o Communication with Mrs VC and family representatives
o Care and treatment (with a focus upon medication management, needs assessment, weight and nutrition)
o Managing concerns / complaints
Mrs VC lived in care home in Gateshead, during the first four months of her stay within the care home the family were happy with her care. Concerns were subsequently raised by the family with respect to how the home and partners responded to her deteriorating physical and mental health and associated increased care and support needs.
A copy of the Powerpoint Presentation from the Interactive Workshop can be found here Mrs VC Appreciative Inquiry (PDF) [391KB] .
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